Ovarian Germ Cell Tumors
General Information(Symptoms and Diagnosis)
Stages
Treatment
Treatment Options By Stage
General Information About Ovarian Germ Cell Tumors
Key Points
- Ovarian germ cell tumor is a disease in which malignant
(cancer) cells form in the germ (egg) cells of the ovary.
- Signs of ovarian germ cell tumor are swelling of the
abdomen or vaginal bleeding after menopause.
- Tests that examine the ovaries, pelvic area, blood, and
ovarian tissue are used to detect (find) and diagnose ovarian germ cell
tumor.
- Certain factors affect prognosis (chance of recovery and
treatment options).
Ovarian
germ cell tumor is a disease in which malignant (cancer) cells form in
the germ (egg) cells of the ovary.
Germ
cell tumors begin in the reproductive
cells (egg or sperm)
of the body. Ovarian
germ cell tumors usually occur in teenage girls or young
women and most often affect just one ovary.
The ovaries
are a pair of organs
in the female reproductive
system. They are in the pelvis,
one on each side of the uterus
(the hollow, pear-shaped organ where a fetus
grows). Each ovary is about the size and shape of an almond. The
ovaries make eggs and female hormones.
Anatomy of the female
reproductive system. The organs in the female reproductive system
include the uterus, ovaries, fallopian tubes, cervix, and vagina. The
uterus has a muscular outer layer called the myometrium and an inner
lining called the endometrium.
Ovarian germ cell tumor
is a general name that is used to describe several different types of cancer.
The most common ovarian germ cell tumor is called dysgerminoma.
See the following PDQ
summaries for information about other types of ovarian tumors:
- Ovarian
Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment
- Ovarian
Low Malignant Potential Tumors Treatment
Signs
of ovarian germ cell tumor are swelling of the abdomen or vaginal
bleeding after menopause.
Ovarian germ cell tumors
can be hard to diagnose
(find) early. Often there are no symptoms
in the early stages,
but tumors may be found during regular gynecologic
exams (checkups). Check with your doctor if you have either of the
following:
- Swollen abdomen
without weight gain in other parts of the body.
- Bleeding from the vagina
after menopause
(when you are no longer having menstrual
periods).
Tests
that examine the ovaries, pelvic area, blood, and ovarian tissue are
used to detect (find) and diagnose ovarian germ cell tumor.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Pelvic
exam : An exam of the vagina, cervix,
uterus, fallopian
tubes, ovaries, and rectum.
A speculum
is inserted into the vagina and the doctor or nurse
looks at the vagina and cervix for signs of disease. A Pap
test of the cervix is usually done. The doctor or nurse
also
inserts one or two lubricated,
gloved fingers of one hand into the vagina and places the other hand
over the lower abdomen to feel the size, shape, and position of the
uterus and ovaries. The doctor or nurse also inserts a lubricated,
gloved finger into the rectum to feel for lumps or abnormal
areas.
Pelvic exam. A doctor
or nurse inserts one or two lubricated, gloved fingers of one hand into
the vagina and presses on the lower abdomen with the other hand. This
is done to feel the size, shape, and position of the uterus and
ovaries. The vagina, cervix, fallopian tubes, and rectum are also
checked.
- Laparotomy
: A surgical
procedure in which an incision
(cut) is made in the wall of the abdomen
to check the inside of the abdomen for signs of disease. The size of
the incision depends on the reason the laparotomy is being done.
Sometimes organs
are removed or tissue
samples are taken and checked under a microscope
for signs of disease.
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, taken from
different angles. The pictures are made by a computer linked to an x-ray
machine. A dye
may be injected
into a vein
or swallowed to help the organs or tissues show up more clearly. This
procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- Serum
tumor marker test : A procedure in which a
sample of blood
is checked to measure the amounts of certain substances released into
the blood by organs, tissues, or tumor cells in the body. Certain
substances are linked to specific types of cancer when found in
increased levels in the blood. These are called tumor
markers. An increased level of alpha
fetoprotein (AFP) or human
chorionic gonadotropin (HCG) in the blood may be a sign of
ovarian germ cell tumor.
Certain
factors affect prognosis (chance of recovery and treatment options).
The prognosis
(chance of recovery)
and treatment options depend on the following:
- The type of cancer.
- The size of the tumor.
- The stage of cancer (whether it affects part of the ovary,
involves the whole ovary, or has spread to other places in the body).
- The way the cancer cells look under a microscope.
- The patient's general health.
Ovarian germ cell tumors
are usually cured
if found and treated early.
Stages of Ovarian Germ Cell Tumors
Key Points
- After ovarian germ cell tumor has been diagnosed, tests are
done to find out if cancer cells have spread within the ovary or to
other parts of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The following stages are used for ovarian germ cell tumors:
- Stage I
- Stage II
- Stage III
- Stage IV
After
ovarian germ cell tumor has been diagnosed, tests are done to find out
if cancer cells have spread within the ovary or to other parts of the
body.
The process used to find
out whether cancer
has spread within the ovary
or to other parts of the body is called staging.
The information gathered from the staging process determines the stage
of the disease. Unless a doctor is sure the cancer has spread from the
ovaries to other parts of the body, an operation called a laparotomy
is done to see if the cancer has spread. The doctor must cut into the abdomen
and carefully look at all the organs
to see if they have cancer in them. The doctor will cut out small
pieces of tissue
so they can be checked under a microscope
for signs
of cancer. The doctor may also wash the abdominal
cavity
with fluid,
which is also checked under a microscope to see if it has cancer cells
in it. Usually the doctor will remove the cancer and other organs that
have cancer in them during the laparotomy. It is important to know the
stage in order to plan treatment.
Many of the tests used
to diagnose
ovarian
germ cell tumor are also used for staging. The following
tests and procedures may also be used for staging:
- PET
scan (positron emission tomography scan): A
procedure to find malignant
tumor
cells in the body. A small amount of radioactive
glucose
(sugar) is injected
into a vein.
The PET scanner
rotates around the body and makes a picture of where glucose is being
used in the body. Malignant tumor cells show up brighter in the picture
because they are more active and take up more glucose than normal cells
do.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio
waves, and a computer to make a series of detailed
pictures
of areas inside the body. This procedure is also called nuclear
magnetic resonance imaging (NMRI).
- Transvaginal
ultrasound exam: A procedure used to
examine
the vagina,
uterus,
fallopian
tubes, and bladder.
An ultrasound
transducer (probe) is inserted into the vagina and used to
bounce high-energy sound waves (ultrasound) off internal tissues or
organs and make echoes. The echoes form a picture of body tissues
called a sonogram.
The doctor can identify tumors by looking at the sonogram.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue,
the lymph
system, and the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph
vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood
vessels to other parts of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells
break away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor
(metastatic
tumor) in another part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of tumor as the primary tumor. For example, if an ovarian
germ cell tumor spreads to the liver,
the tumor cells in the liver are actually cancerous ovarian germ cells.
The disease is metastatic ovarian germ cell tumor, not liver cancer.
The
following stages are used for ovarian germ cell tumors:
Stage
I
In stage IA, cancer is
found inside a single ovary or fallopian tube. In stage IB, cancer is
found inside both ovaries or fallopian tubes. In stage IC, cancer is
found inside one or both ovaries or fallopian tubes and one of the
following is true: (a) the capsule (outer covering) of the ovary has
ruptured, (b) cancer is also found on the outside surface of one or
both ovaries or fallopian tubes, or (c) cancer cells are found in the
pelvic peritoneum.
In stage
I, cancer
is found in one or both ovaries.
Stage I is divided into stage IA, stage IB, and stage IC.
- Stage
IA: Cancer is found inside a single ovary.
- Stage
IB: Cancer is found inside both ovaries.
- Stage
IC: Cancer is found inside one or both ovaries
and one of the following is true:
- cancer is also found on the outside surface of one or
both ovaries; or
- the capsule
(outer covering) of the ovary has ruptured (broken open); or
- cancer cells are found in the fluid
of the peritoneal
cavity (the body cavity
that contains most of the organs
in the abdomen)
or in washings
of the peritoneum
(tissue
lining the peritoneal cavity).
Stage
II
In stage IIA, cancer is
found in one or both ovaries or fallopian tubes and has spread to the
uterus and/or the fallopian tubes and/or the ovaries. In stage IIB,
cancer is found in one or both ovaries or fallopian tubes and has
spread to the colon. In primary peritoneal cancer, cancer is found in
the pelvic peritoneum and has not spread there from another part of the
body.
In stage
II, cancer
is found in one or both ovaries
and has spread into other areas of the pelvis.
Stage II is divided into stage IIA, stage IIB, and stage IIC.
- Stage
IIA: Cancer has spread to the uterus
and/or fallopian
tubes (the long slender tubes through which eggs pass from
the ovaries
to the uterus).
- Stage
IIB: Cancer has spread to other tissue
within the pelvis.
- Stage
IIC: Cancer is found inside one or both ovaries
and has spread to the uterus
and/or fallopian
tubes, or to other tissue
within the pelvis.
Also, one of the following is true:
- cancer is found on the outside surface of one or both
ovaries; or
- the capsule
(outer covering) of the ovary has ruptured (broken open); or
- cancer cells
are found in the fluid
of the peritoneal
cavity (the body cavity
that contains most of the organs
in the abdomen)
or in washings
of the peritoneum
(tissue
lining the peritoneal cavity).
Pea, peanut, walnut, and
lime show tumor sizes.
Stage
III
In stage
III, cancer
is found in one or both ovaries
and has spread outside the pelvis
to other parts of the abdomen
and/or nearby lymph
nodes. Stage III is divided into stage IIIA, stage IIIB,
and
stage IIIC.
- Stage
IIIA: The tumor
is found in the pelvis
only, but cancer
cells
that can be seen only with a microscope
have spread to the surface of the peritoneum
(tissue
that lines the abdominal
wall and covers most of the organs in the abdomen),
the small
intestines, or the tissue that connects the small
intestines
to the wall of the abdomen.
In stage IIIA, cancer
is found in one or both ovaries or fallopian tubes and (a) cancer has
spread to lymph nodes in the area outside or behind the peritoneum
only, or (b) cancer cells that can be seen only with a microscope have
spread to the omentum. Cancer may have spread to nearby lymph nodes.
- Stage
IIIB: Cancer has spread to the peritoneum
and the cancer in the peritoneum is 2 centimeters
or smaller.
In stage IIIB, cancer
is found in one or both ovaries or fallopian tubes and has spread to
the omentum, and the cancer in the omentum is 2 centimeters or smaller.
Cancer may have spread to lymph nodes behind the peritoneum.
- Stage
IIIC: Cancer has spread to the peritoneum
and the cancer in the peritoneum is larger than 2 centimeters
and/or cancer has spread to lymph
nodes in the abdomen.
In stage IIIC, cancer
is found in one or both ovaries or fallopian tubes and has spread to
the omentum, and the cancer in the omentum is larger than 2
centimeters. Cancer may have spread to lymph nodes behind the
peritoneum or to the surface of the liver or spleen.
Cancer that has spread
to the surface of the liver
is also considered stage III ovarian
cancer.
Stage
IV
In stage IV, cancer has
spread beyond the abdomen to other parts of the body. In stage IVA,
cancer cells are found in extra fluid that builds up around the lungs.
In stage IVB, cancer has spread to organs and tissues outside the
abdomen, including the lung, liver, bone, and lymph nodes in the groin.
In stage
IV, cancer
has spread beyond the abdomen
to other parts of the body, such as the lungs
or tissue
inside the liver.
Cancer cells
in the fluid
around the lungs is also considered stage IV ovarian
cancer.
Recurrent Ovarian Germ Cell Tumors
Recurrent
ovarian
germ cell tumor is cancer
that has recurred (come back) after it has been treated. The cancer may
come back in the other ovary
or in other parts of the body.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
ovarian germ cell tumors.
- Four types of standard treatment are used:
- Surgery
- Observation
- Chemotherapy
- Radiation therapy
- New types of treatment are being tested in clinical trials.
- High-dose chemotherapy with bone marrow transplant
- New treatment options
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with ovarian germ cell
tumors.
Different types of
treatment are available for patients with ovarian
germ cell tumor. Some treatments are standard
(the currently used treatment), and some are being tested in clinical
trials. A treatment clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new treatment may become the standard
treatment. Patients may want to think about taking part in a clinical
trial. Some clinical trials are open only to patients who have not
started treatment.
Four
types of standard treatment are used:
Surgery
Surgery
is the most common treatment of ovarian germ cell tumor. A doctor may
take out the cancer using one of the following types of surgery.
- Unilateral
salpingo-oophorectomy: A surgical procedure to remove one ovary
and one fallopian
tube.
- Total
hysterectomy: A surgical procedure to remove the uterus,
including the cervix.
If the uterus and cervix are taken out through the vagina,
the operation is called a vaginal
hysterectomy. If the uterus and cervix are taken out through a large incision
(cut) in the abdomen,
the operation is called a total abdominal
hysterectomy. If the uterus and cervix are taken out through a small
incision (cut) in the abdomen using a laparoscope,
the operation is called a total laparoscopic hysterectomy.
Hysterectomy. The
uterus is surgically removed with or without other organs or tissues.
In a total hysterectomy, the uterus and cervix are removed. In a total
hysterectomy with salpingo-oophorectomy, (a) the uterus plus one
(unilateral) ovary and fallopian tube are removed; or (b) the uterus
plus both (bilateral) ovaries and fallopian tubes are removed. In a
radical hysterectomy, the uterus, cervix, both ovaries, both fallopian
tubes, and nearby tissue are removed. These procedures are done using a
low transverse incision or a vertical incision.
- Bilateral
salpingo-oophorectomy: A surgical procedure to remove both
ovaries and both fallopian tubes.
- Tumor
debulking: A surgical procedure in which as much of the tumor
as possible is removed. Some tumors cannot be completely removed.
Even if the doctor
removes all the cancer that can be seen at the time of the operation,
some patients may be offered chemotherapy or radiation therapy after
surgery to kill any cancer cells that are left. Treatment given after
the surgery, to lower the risk that the cancer will come back, is
called adjuvant
therapy.
After chemotherapy
for an ovarian germ cell tumor, a second-look
laparotomy
may be done. This is similar to the laparotomy that is done to find out
the stage
of the cancer. Second-look laparotomy is a surgical procedure to find
out if tumor cells
are left after primary
treatment. During this procedure, the doctor will take
samples of lymph
nodes and other tissues
in the abdomen to see if any cancer is left. This procedure is not done
for dysgerminomas.
Observation
Observation
is closely watching a patient's condition
without giving any treatment unless signs
or symptoms
appear or change.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing. When chemotherapy is taken by mouth or injected
into a vein
or muscle, the drugs enter the bloodstream and can reach cancer cells
throughout the body (systemic
chemotherapy). When chemotherapy is placed directly into
the cerebrospinal
fluid, an organ,
or a body cavity
such as the abdomen, the drugs mainly affect cancer cells in those
areas (regional
chemotherapy). Combination
chemotherapy is treatment using more than one anticancer
drug. The way the chemotherapy is given depends on the type and stage
of the cancer being treated.
See Drugs
Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
for more information.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External
radiation therapy uses a machine outside the body to send
radiation toward the cancer.
- Internal
radiation therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage of the cancer being
treated. External radiation therapy is used to treat ovarian germ cell
tumors.
New
types of treatment are being tested in clinical trials.
This summary section
describes treatments that are being studied in clinical trials. It may
not mention every new treatment being studied. Information about
clinical trials is available from the NCI
website.
High-dose
chemotherapy with bone marrow transplant
High-dose
chemotherapy with bone
marrow transplant is a method of giving very high doses
of chemotherapy and replacing blood
-forming cells destroyed by the cancer treatment. Stem
cells (immature blood cells) are removed from the bone
marrow of the patient or a donor
and are frozen and stored. After the chemotherapy is completed, the
stored stem cells are thawed and given back to the patient through an infusion.
These reinfused stem cells grow into (and restore) the body's blood
cells.
New
treatment options
Combination
chemotherapy (the use of more than one anticancer drug) is
being tested in clinical trials.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical
trial may be the best treatment choice. Clinical trials
are
part of the cancer research process. Clinical trials are done to find
out if new cancer treatments are safe and effective or better than the standard
treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring
(coming back) or reduce the side
effects of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to
see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of
these tests.
Some of the tests
will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up
tests or check-ups.
Treatment Options By Stage
Stage I Ovarian Germ Cell Tumors
Treatment depends on
whether the tumor
is a dysgerminoma
or another type of ovarian
germ cell tumor.
Treatment of
dysgerminoma may include the following:
- Unilateral
salpingo-oophorectomy with or without lymphangiography
or CT
scan.
- Unilateral salpingo-oophorectomy followed by observation.
- Unilateral salpingo-oophorectomy followed by radiation
therapy.
- Unilateral salpingo-oophorectomy followed by chemotherapy.
Treatment of other
ovarian germ cell tumors may be either:
- unilateral salpingo-oophorectomy followed by careful
observation; or
- unilateral salpingo-oophorectomy, sometimes followed by combination
chemotherapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage
I ovarian germ cell tumor. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stage II Ovarian Germ Cell Tumors
Treatment depends on
whether the tumor
is a dysgerminoma
or another type of ovarian
germ cell tumor.
Treatment of
dysgerminoma may be either:
- total abdominal
hysterectomy
and bilateral
salpingo-oophorectomy followed by radiation
therapy or combination
chemotherapy; or
- unilateral
salpingo-oophorectomy followed by chemotherapy.
Treatment of other
ovarian germ cell tumors may include the following:
- Unilateral salpingo-oophorectomy followed by combination
chemotherapy.
- Second-look
laparotomy
(surgery
done after primary
treatment to see if tumor
cells
remain).
- A clinical
trial of a new treatment.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage
II ovarian germ cell tumor. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stage III Ovarian Germ Cell Tumors
Treatment depends on
whether the tumor
is a dysgerminoma
or another type of ovarian
germ cell tumor.
Treatment of
dysgerminoma may include the following:
- Total abdominal
hysterectomy
and bilateral
salpingo-oophorectomy, with removal of as much of the cancer
in the pelvis
and abdomen
as possible.
- Unilateral
salpingo-oophorectomy followed by chemotherapy.
Treatment of other
ovarian germ cell tumors may include the following:
- Total abdominal hysterectomy and bilateral
salpingo-oophorectomy, with removal of as much of the cancer in the
pelvis and abdomen as possible. Chemotherapy will be given before
and/or after surgery.
- Unilateral salpingo-oophorectomy followed by chemotherapy.
- Second-look
laparotomy
(surgery
done after primary
treatment to see if tumor
cells
remain).
- A clinical
trial of a new treatment.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage
III ovarian germ cell tumor. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stage IV Ovarian Germ Cell Tumors
Treatment depends on
whether the tumor
is a dysgerminoma
or another type of ovarian
germ cell tumor.
Treatment of
dysgerminoma may include the following:
- Total abdominal
hysterectomy
and bilateral
salpingo-oophorectomy followed by chemotherapy,
with removal of as much of the cancer
in the pelvis
and abdomen
as possible.
- Unilateral
salpingo-oophorectomy followed by chemotherapy.
Treatment of other
ovarian germ cell tumors may include the following:
- Total abdominal hysterectomy and bilateral
salpingo-oophorectomy, with removal of as much of the cancer in the
pelvis and abdomen as possible. Chemotherapy will be given before
and/or after surgery.
- Unilateral salpingo-oophorectomy followed by chemotherapy.
- Second-look
laparotomy
(surgery
done after primary
treatment to see if tumor
cells
remain).
- A clinical
trial of a new treatment.
Treatment Options for Recurrent Ovarian Germ Cell Tumors
Treatment depends on
whether the tumor
is a dysgerminoma
or another type of ovarian
germ cell tumor.
Treatment of
dysgerminoma may be:
- Chemotherapy
with or without radiation
therapy.
Treatment of other
ovarian germ cell tumors may include the following:
- Chemotherapy.
- Surgery
with or without chemotherapy.
- A clinical
trial of high-dose
chemotherapy followed by bone
marrow transplant.
- A clinical trial of a new treatment.
-NIH
